Reorienting After Trauma: From Yom Kippur War Hero to PTSD Pioneer | Dr. Yuval Neria

A decorated tank commander and recipient of Israel's Medal of Valor sits down with us to rethink how trauma is understood and treated. Dr. Yuval Neria recounts twelve brutal days during the 1973 Yom Kippur War—where he was severely injured and awarded the Medal of Valor (equivalent to the U.S. Medal of Honor)—that taught him to filter bad orders, protect his crews, and update reality on the fly, a mindset that later shaped his groundbreaking research on PTSD.

He explains a pivotal distinction: trauma is the event; the disorder is the emotional charge welded to memory. The job of recovery is to separate the two, restore meaning, and rebuild trust. We explore why three people can share a firefight and come away with different scars. Capacity varies—genetics, sleep, prior wounds, and the deeply interpersonal nature of harm all matter. Prisoners of war often face heavier burdens because cruelty was targeted and identity-stripping. Early support after homecoming is decisive; without it, sleep fails, depression blooms, and people chase relief through alcohol, marijuana, or compulsions. One-size-fits-all treatment misses the mark, especially when anxiety-heavy cases diverge from depression-dominant, morally injured profiles.

From leading a battalion in the 1982 Lebanon War to founding the Columbia-NYP Military Family Wellness Center and pioneering equine-assisted the

John R. Boyd's Conceptual Spiral was originally titled No Way Out. In his own words: 

“There is no way out unless we can eliminate the features just cited. Since we don’t know how to do this, we must continue the whirl of reorientation…”

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John Boyd’s Conceptual Spiral was originally titled “No Way Out.” In his words:

“There is no way out unless we can eliminate the features just cited. Since we don’t know how to do this, we must continue the whirl of reorientation…”

Download a complete transcript of Conceptual Spiral for free by clicking here.

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Chapters

• 0:00 Welcome And Background
• 2:33 Early Military Roots And Family
• 4:15 Yom Kippur War: Twelve Defining Days
• 10:05 Leadership Under Fire And Hard Lessons
• 13:22 Valor Without Recklessness
• 16:48 Sleep, Adrenaline, And Survival
• 20:08 Transition To Scholarship And Writing
• 25:31 Meaning, Identity, And PTSD Origins
• 30:46 Why Trauma Impacts People Differently
• 35:36 Treatment Goal: Unlink Memory And Emotion
• 40:11 The Case For Psychedelics And Brain Reset
• 45:26 Exercise, Animals, And Nonverbal Healing
• 50:31 Addiction, Relief Seeking, And Risk
• 53:26 Sexual Assault In The Ranks
• 58:36 Integration Of Women And Culture
• 1:02:46 Closing Reflections And Next Steps

Transcript

Dr. Yuval Neria : 0:20

In our center, et cetera. So psychedelics, glutamate system, et cetera, I'm not as you know fluent there. Just excuse me for that. That's okay. You know, genetics, but all the rest, you know, I'm okay with.

Mark McGrath: 0:33

Well, I'm I'll start we'll we'll start recording, but the first thing, I guess the first question is, what do you want us to call you? Because our our our uh as officers, we go right to doctor. So what do you what do you wish to be called? Doctor Maria is okay. That's fine. We will call you, we will call you. Now we're both from the naval branches, our medics and doctors, we always call Doc. So if we if we call you Doc, please don't take a look. It's okay too. Yeah, go ahead. Okay, it's it's it's cultural affinity, but in that we've started, we want to say, first of all, what an honor it is to really have you here with us. Someone who, like like us and a lot of our listeners, um you know, former, former officer, trained as a warfighter. Your experiences and your story are are so amazing and getting us to the point where you've dedicated a career based off that beginning experience that has helped so many and continues to reach out to so many, which is one of our missions that Brian and I have, that Punch and I have here on No Way Out and our Substack, the World of Reorientation, is to understand PTSD and get people the help that they need. We're biased because we're also veterans, but also to the people that have experienced trauma in other ways, and there's first responders and 9-11 survivors and sexual assault and things like that. So we're so glad to have you here, Doc. It means a great deal. And maybe we could begin with painting the picture of your story as going into the army and your experiences there that have informed and inspired the rest of your career and you know what you're what you're widely known for, other than PTSD. Maybe if you could help paint the picture for our audience.

Dr. Yuval Neria : 2:11

Sure. It's it's great to be here. It's a great pleasure to be here and um and and to speak to you today, guys. So I was born to um to a military family, actually, in in Israel, sometimes in the 50s. And so it's about uh more than 70 years ago. Hard to believe, but that's that's the truth. My my um dad and my mother were both in the military and as professional officers. Um my father was in the infantry, my mother was she was a medic and actually a very brave medic uh during the war of independence and um grew up um uh really hungry to one day to join the military. Uh I remember um that um right after the Six Days War, I was 14 or 15 years of age, and my father uh put a a uniform on me and asked me to uh be his uh driver on on on the Jeep on the on the he was he was a battalion commander at at the Golan Heights, and um he offered me to to drive his Jeep and and nobody knew that a kid 14 or 15 years old, you know, driving this Jeep, and um so just to give you a flavor of what a crazy family I was born to, and a father that took a lot of risk always in his life. I miss him dearly. He died 10 years ago, and actually yesterday was was anniversary for his death. So um and I I joined them I was wasn't a good student in high school, in fact, and uh but always thought that things would be okay. And I joined the military and I was screened for for a special ops unit and and failed, you know, the screening and and um and and was asked to join the the armor forces and did it happily. And I became a tank driver first and very quickly a tank commander, and very quickly got to officer training, became became um um became um a commander, you know, a lieutenant, and then as um the deputy platoon commander went to the Yom Kippur at the north side of the Suez Canal, um where the Egyptians um you know the IDF on October 63, and I was I was old at this point? I was I was 21, exactly. And I was I was part of this um very difficult times for 12 days um until I was injured, severely injured and evacuated. And those 12 days when I was 21 really shaped my life forever. I'm sure you guys, Ponch and Moose, can understand it how, you know, few days, you know, of combat um can throw us to almost like a different existence and shape everything that we do after or feel after, you know, those days.

unknown: 5:53

Yeah.

Mark McGrath: 5:54

Talk us through so so 12 days. You're you know, when you when you read what what's available about you on the internet, I'd love to hear it in your own words of of what that was actually like as because as a as a as a leader, and imagine that you had to inspire people people that were with you, people that were people that were under you, working as a team. Talk us through that from that perspective of how the Yeah, so that's I appreciate the opportunity.

Dr. Yuval Neria : 6:25

It's only 12 days, but I can talk about it for like an entire you know night. I'm very much into the details, you know, of what happened to us, but basically um I have been through um um experiences where you know battalion, you know, full, you know, armor tank, but tank battalion pattern, by the way, patron tanks M60, M48, I think, uh was completely destroyed in less than 24 hours, and which made me looking for another unit, kind of, you know, the second day of the war, joined this unit through, you know, after I was particularly um, you know, had to deal with um bringing back everybody that survived this combat of the first you know, the first day and night. So I was going again and again to um places where I thought my tank crews can be still found and put them on my tank, you know, almost like a track. I used my tank almost like a track, you know, like a pickup truck in order to take people outside of the combat zone during night. And the Egyptians were there already, and they didn't um they didn't notice that this is an Israeli um you know um vehicles that moving back and forth in order to rescue crew members who were still alive, and we left, you know, some of the tanks either in the swamps there or those tanks that were already heated and destroyed, and some of them were on fire. But anyhow, my mind was to rescue as many, you know, young kids uh under my command uh to um to back you know two, three kilometers, and so I did that, and in addition to fighting in the beginning quite a bit, and then I was able to join another unit to participate in more battles. My tanks were destroyed a couple of times. I changed a number of tanks, you know, um, with always like new crew members under my command, and I I um and eventually um positioned in a company commander role after three days in a complete different unit that were um that were more successful to um stay alive and cohesive and with a very the great you know leadership of the battalion commander. So let me just instead of going into detail, let me just tell you that my main lesson of those days, you know, is that you have to fight the enemy, but you also have to be very conscious about not to get bad advice or bad commands from superiors. So I was kind of the middle, really filtering out as much as I can what other people tell me what to do and me deciding what to do. In order to stay alive, to stay safe, and to defend my people from bad uh decisions, bad requests coming from above. I think that so I was able, so my psychology was how can I gain enough independence and enough space you know to operate more safely? So I didn't so it's true that you know I got and you're gonna I'm sure ask me about it. So how did you get this um you know, medal of bravery that you got? And my answer will be it's not because I was crazy, I was kind of suicidal, no, I was under control and kind of filtering out and digesting well what's going on around me.

Mark McGrath: 11:11

Well, that ties in perfectly. Well, that that that really does pivot nicely into the work that we do and and and and and what I think we're gonna we're gonna build so many bridges with you on. One technical question in those 12 days, did you sleep?

Dr. Yuval Neria : 11:25

So very little, very little, sometimes in some crazy ways. So, for example, the worst, the worst, you know, bombardment that we got with do you remember the Russian weapon Katyusha? The Katyusha thing? Katyusha was kind of mortar machine that's throwing on you dozens and dozens of of like little missiles at the same time, you know, from so they have these like six or twelve, you know, things that they throw on you, like you know, like this mortar and whatever. Name's Katyusha. This is like a Russian name. And awful, awful sound, terrible risk, really awful, and I was sleeping like a baby, you know, on the tank, but outside of the tourette. So I slept when I could. I slept, you know, um during like crazy circumstances, but yeah, I didn't feel the fatigue so much. I was so much with so much adrenaline and and you know, so this is I felt other things, but fatigue not so much.

Mark McGrath: 12:42

What's what's what I love about your when you talk about not being suicidal or crazy when it came to being a recipient of the Medal of Valor, which for our American listeners is the equivalent to the Congressional Medal of Honor and has only been awarded, you're you're one of 40 people that have ever been awarded this decoration. Your your answer and Ponch, did you pick up on it? Doc, your answer was I kept shattering my correspondence of reality, and I kept revising and updating my situation so that I had you you you weren't uh it seems to me like you were fighting against biases or training or whatever. You were dealing with reality as it was, and you were updating your cognitive operating system, which in turn shaped how you sensed, how you decided, how you acted, how you learned, in order that you could thrive and improve your capacity for free and independent action.

Dr. Yuval Neria : 14:32

Absolutely. And that's why I am alive today. I was alive after the war. Exactly that.

Mark McGrath: 14:38

Wow. Yeah. Well, that's that's um for again for the things that we talk about, that that really uh that really does lay a phenomenal foundation. Now you you you get past that, and as you now I want to ask about your transition into becoming a clinician, um a scholar on PTSD. And I guess there's a there's a parallel path that you were you're still in the reserves and you you you were called back to war again nine years later, and you've been involved in other things. Now walk us through that transition of what was the inspiration from that, and how did you get to the through the next nine years?

Dr. Yuval Neria : 15:18

So the inspiration was very much related to my emotional wounds after the war. Um I like many, many others, I came back with the need to deal with my own trauma, with my um big questions about myself. How did I function? Whether I deserve to be a hero, you know, and in Israel it was a big thing that I got this medal um of Valor because, you know, during the Yom Kippu War, there were only eight people that got the Medal of Valors. Four of them were dead already, so only four of us. And we had to be interviewed about that, a lot of press, a lot of admiration. And for me as a young kid, I I had to ask myself, you know, uh, do I deserve it? You know, is it is it the right thing that um that happened to me? And so I got into um a lot of um kind of source searching and um trying to understand who I am, you know, what should I do, and um and also in a way trying to understand generations before me, you know, my parents that very likely had PTSD as well from their combat experience. And you know, the generation of Holocaust survivors who were coming to Israel with a lot of emotional wounds. So um so for me it was very natural to pick on psychology and clinical understanding of myself and others, and but um I always thought that I I had a role, you know, and that's something that I think perhaps you can understand it as a group of um of young people who who are trying to accomplish um of kind of a societal role in what you are doing with your you know podcast, your your kind of intellectual um advantage. It was also true for me what what is it that I should become to or do? And um and then luckily I have great mentorship in Israel and that kind of pointed me to do both writing. I I published a book which became kind of a um uh a best seller in Israel on it was a war docker, it was about my war experiences, but written as a novel, as a war novel, and um helping me really to shape my ideas about war and peace, about you know, my expectations towards you know my military leaders and and political leaders and and and my disappointments and kind of a typical uh kind of come to age type of writing. But then I move to research and um in particular I try to understand severe trauma, extreme trauma, and and PTSD in combat veterans and and prisoners of wars in Israel. That's what's kind of set me up on the field of PTSD initially. We don't hear you mostly. Sorry.

Mark McGrath: 19:02

So that book was called Fire, correct? Right, exactly. I mean the English were it was that ever published in English?

Dr. Yuval Neria : 19:11

No. I mean, no, it's it's translated, never published in Israel. Okay. No, I'd love to. Never published uh abroad, I mean, yeah, in in this country yet.

Mark McGrath: 19:20

Well, hopefully that would be that would be something uh wonderful. I can come to mind of th of things I've heard of, like war novels like Fields of Fire, that a lot of our audience would be familiar with by James Webb and some other sorts of memoirs.

Dr. Yuval Neria : 19:34

You know, fire fire has like dual or triple meaning, right? Fire is both both, you know, the command, the order that you give your people to, you know, to shoot, right? And so he said, you know, to my to your crew member, he said, to the gunner, he said, fire. And then he, you know, they need to shoot, but also fire is, you know, is what happened to me and to so many people and that our vehicles, army vehicles, you know, caught on fire when heated, and so I I got back home with um need to deal with with burn burns, you know, and and other you know injuries. So but there is also fire on the on on the positive sense that there is fire in in my soul, you know, to do the right thing, right? We are fired up, right? So that's kind of the triple meaning of that.

Mark McGrath: 20:42

So by the time you got to the next war in Lebanon, and now you're a battalion commander? Yeah, I was I was a battalion commander, right? How were you applying those lessons and those things that you were starting to explore around trauma and everything? How did that how did that inform your leadership as an officer at that level and that fight?

Dr. Yuval Neria : 21:02

I know. That's that's really so I I had yet to have my PhD then. I was only I was so this is 82, I was 30 years old, young battalion commander, with my Previous war experiences really very fresh in my mind. And once again, guys, you know, my main commitment was how can I stay alive and keep my battalion under and under control, right? Against the crane zenith around me. So that's what also connects to the trauma of the previous war because I was so sick and tired of military officers who are irresponsibly and take their and take their um you know military units to all sorts of um you know um unresponsible, you know, missions that are going to be ended bad. So I was very much, you know, trying to be on control, and it's proven right. I mean, I was again pretty cautious. I mean, I was fierce. I mean, it's not that I was weak. I I felt emboldened to do the right thing militarily, even better than the previous war, because my position was a little bit higher with more control. I mean, a battalion commander in the IDF, I don't know whether it's it's comparable to what you guys know uh in the military here, but it's quite an independent, you know. Um, you know, there is some independence, and because it's it's it's a a military formation they they that can operate more independently. I felt I so I think I did well. I know that I did pretty well. Politically I had a problem um with this war, by the way. Uh you know, I I I didn't ignore the um the political complications, you know. I wasn't I wasn't clear whether it's whether entering to to this country, to Lebanon, I'm talking about 82, about what, 50 years ago or more, that this was the right thing to do, but I was loyal. I was loyal to my guys and and to the militaries. I did that nevertheless, but again, you know, I I you know I tried to be as cautious, as moral, as you know, a fine leader as I could.

Mark McGrath: 24:18

How did you as so having been through war already, have having been decorated at the highest level, and also injured, I was a disabled veteran.

Dr. Yuval Neria : 24:27

In a disabled I got disability from the Israeli VA already as well.

Mark McGrath: 24:33

Yeah. And and then Yom Kippur war having such because you talk about this in your professional work, how there is such cultural collective PTSD about this. How was it as now the the senior officer in command of a battalion? How did you take steps? What things did you do to mentor or coach those that were brand new that had never been in combat, that had never been in the community? Yeah, no.

Dr. Yuval Neria : 24:56

Yeah, that's that's a good question. I mean, that's by the way, why I was, you know, joining um as a military again as a reservist. I I I I love that. I love the fact that I have 400 kids, you know, under my command, that I can train them appropriately, I can mentor them, you know, the the company commanders. And also it's it's a little bit childish, guys, but I love the tanks. I love driving this vehicle, I love shooting from this vehicle, I love driving jeeps. I it's it's like, you know, so there is war, and war is terrible, but there is a daily life of the military that are so enjoyable. And, you know, so I got a little bit trapped in that because of my childish personality.

Mark McGrath: 25:57

That's awesome. What were some of so what what would be some of the things then for to to embolden or encourage people that had not been there and you had been there? Like what were some of the things that you would take into consideration when when when emulating or modeling or mentoring them, as you say?

Dr. Yuval Neria : 26:13

Being professional, being as professional as you can, you know, knowing what you how to be a good a good soldier, being fair, being honest, being transparent, being loyal to the people around you and under you, being being being honest in your reports to your superiors. I mean, I always and I and also it's true, you know, as a lab, as a lab director in the in the university for so many years, you know, it's the same values. I mean, keep it honest, you know, it's not about it's not about um it's it's a collective effort, it's not about individually here and there. We are together, let's define the mission, let's work together as a unit towards accomplishing the mission. So this model of being within a group, leading a group, is what it what kind of made my life, you know, pretty effective until this point.

Mark McGrath: 27:21

So now we let's pivot into the to the the the the work that you've been known for since. And let's start there, really, because the things that you just described when you think of strict but fair mission, camaraderie, unit cohesion, patriotism, love of vehicles. I mean, Ponch loves jets and I love cannons. I mean, I still do. What do you think that what effect does that? Maybe let's start with that as we get into the discussion of trauma and PTSD. What those things that make the military what it is and give us this sort of cognitive operating system that we carry with us for the rest of our lives that many people do not have that have never been there, what trauma comes from that when veterans leave the military and they transition into the the world or the civilian world? Is that some of the places that really attack the mind and feelings and sense making of a of a vet when they when they transition?

Dr. Yuval Neria : 28:21

So this is really the million-dollar question, right? What truly drives and the and the con the emotional consequences of the trauma? The trauma is the experience itself, it's not the result, it's not the consequences. So so the way I see it is that during operational phase, during especially if it's repeated, think about special ops or or the marine experience that you're familiar with, and where a unit is Navy Fields, other, when the unit is really experienced trauma again and again in different formats, different pressure points, you know, there is really um a point where the brain is not so effective in processing those experiences or experiences, especially if they are repeated and ongoing and involve injury, death, loss of life of others around you, you know. So perhaps during the experience you are okay with that, you are slightly numb, you are very focused, the LN is is high, but then you know the question is how far the brain can go in order to process difficult experiences. And difficult experiences can be, for example, not being effective, you know, blaming yourself that you didn't do things the right way. Um things that happened to you that contradict your moral campus, contradict your values. Things that happen to you because you were not effective in stopping things that should have been stopped, right? And you you weren't effective in order to stop them. So or a sense of being abandoned, being betrayed, being misled. So those are the things that put you um in a place that when you come home, and especially without the social support of your peers and your friends, you suddenly alone and need to deal with it. Now, if you are an older guy already with family and kids and what and a wife, a spouse, and sud and and suddenly there is a pressure, you know, about going back to things that perhaps lost meaning for you a little bit, you know, then our brain really is not doing, is not able to do what the brain was doing before until a certain point, you know, processing experiences the right way. And then, you know, you see those cracks. People stop sleep being able to sleep well, people are using drugs, especially marijuana alcohol, in order to sleep better, but that makes them dependent. Um depression is kicking in, and big questions becoming very central. What about me? Am I a failure? Am I getting crazy? So, and if you delay, you know, getting help, professional help, for too long, and pretty soon um you can get into severe trouble, really, emotionally, and stop being functional and stop being responsible, et cetera, et cetera, et cetera.

Mark McGrath: 32:14

You brought up meaning, you know, how important is meaning in your work? Because I I think of like when I think of, again, looking at it as a veteran, the meaning, the duty, the sacrifice, the command of other people, the cabrader and the bond with other people, that that provides a lot of meaning. And I wonder if a lot of men and women that transition out, that's what they're still searching for. They're still trying to find the meaning that they had when they were part of a part of a cohesive unit, part of something coming together, sacrificing together, transforming together.

Dr. Yuval Neria : 32:52

So one of the um one of the most important books about meaning and the impossibility of of meaning making after after trauma is a book written by an Italian Jewish guy named Primo Levi, who came back from Auschwitz to his Italian town and and couldn't make couldn't draw a good meaning of what happened to him because what and and the name of the book is Is This a Man? This is a man, right? I mean what what type of manhood, what type of humanity or uh or lack of humanity he has seen. So if you if you are um and eventually, you know, this guy, this famous author really and also ended his life and in an accident that many thought looked more like a suicide than an accident, because he was asking himself, what did I see? I see people, you know, fighting for for a piece of bread and cheating each other and lying to each other and stealing from each other. I see how people are submissive to evil power, and I see people changing their moral code, you know, so easily. Is this, you know, a group of people that I can be part of, you know, and so I don't compare every trauma with the trauma of the Holocaust, especially in Auschwitz or Bickenau. But what I'm saying that is that many of our fellow veterans that are not able to recover from PTSD. And you I'm not speaking about complete recovery. I mean, all of us are staying with memories and some guilt feelings and some bad days and good days. That's normal. That's okay. But still, you know, going to the office and taking care of our kids and spouses and friends, you know, and and and live more or less meaningful life. But for those of us, and you see them in the VA centers that and you see them in other places, you see them in Israel, in Europe, in the US, people who become more chronic cases of BTSD, people who are bitter and angry and blaming and hate themselves and hate everybody else, who are people that were not able to restore their identity as as societal people who completely lost trust in everything around them and in themselves because they have experience, extreme experiences that are that are not digestible so much anymore. And especially if they don't get treatment on time and being able to, you know, draw the right meaning or to reframe what they have experienced.

Mark McGrath: 36:16

That reframing, that reorienting. I mean, that's one of the things that we talk about in that John Boyd, if you look at his Oodaloop sketch, that's you know, that's ultimately through destruction and creation, what he's trying to get us to do is to destroy mental models and create create new ones. Panch, I know you're chomping at the bit to get in on this because you've got a lot to say on this.

Brian "Ponch" Rivera: 36:38

Yeah, I'm I'm curious. Uh I think this is a question that uh a lot of folks want to have answered in in my community. Uh, how is it that uh let's say the three of us are in a tank crew and we experience a horrific event uh and it it only impacts moose, right? How can you help people understand that even though we may have shared an experience, that may impact one of us different? And it's not right or wrong, but can you help people understand what why that is through through your work?

Dr. Yuval Neria : 37:05

Um, thank you for for for the question, um Pancha. And and I know that you're an aviator, um, and it is my sense at least that um you know, questions of resilience and superb functioning and uh versus you know perhaps breaking down under pressure, it's it's very much things that you know you guys try to uh sort out. You know, I'm in this business of of doing research on on um exactly those questions. What are really the factors that will determine who among us or who among any group of people will develop ultimately symptoms and who are those who don't. So let me so let me share with you it's a little bit it's a little bit, you know, based on research, or mostly based on research, but a little bit also speculative and perhaps can guide research down the road. So, first of all, I do believe that there is a limit or even a breaking point for anybody or everybody. Depends on the amount of pressure and trauma that will be put on us. So it's not that some people are like ultimate heroes or resilient people that will never break down. Even those people who are, you know, the strongest among us, even those people with enough lack of sleep, enough pressure, enough fatigue, enough trauma, will eventually break down under the pressure and will need help, right? So that's that's the ultimate model. However, people are different from each other in when exactly this point is identified or located, right? And as I said before, we are built differently. We have different histories, different experiences, different models. We are also coming to face difficulties in a different way. Sometimes we are well rested and ate well or slept well the night before, and sometimes we are not. We are easily confused, we are we don't have enough resources in our body, etc. etc. So this varieties, this variance among us has a lot to do with how we will respond when bad things happen to us. First. Second is that we are the capacity of the computer in our head, crease the the brain, is um it's not limitless. You know, we we don't expect that um our brain can process everything that is thrown on it. So for take for example, you know, prisoners of wars, right? So I've done I've did a big study comparing prisoners of wars to those from to combatants from the same units, army units, with experience exactly the same thing before captivity happened. So I controlled experience in this study. And what I found is that prisoners of war, because they experienced trauma in a very interpersonal way, you know, they faced cruelty and difficulties and lack of sleep and lack of identity, all of that, very differently. Eventually, they some of them really broke down more easily than combatants without a PV experience. So the nature of the trauma is also very, very important. What really happened to you and what did you do eventually? And then comes a homecoming period that I think Moose asked before. That the Most sensitive you know um period is is whether when you came home, what happened to you then? Whether there was somebody there, either your team, your peers, your family, psychologists, the VA system, I don't know what that were there for you, making you more comfortable, you know, to move it to move on in your life when you are not in the military anymore. And think about suicide, for example, in the Marine Corps or in any any other, you know, um other, you know, special ops units. You know, there is it's always happened when those kids, when those young guys are left by themselves to deal with awful memories, really. Self-doubt, self-blame, depression, you know, deep pain, you know, pain is really taking over, like physical pain, deep, deep pain. And there is nobody there that can understand and share and be shared, you know, when they can't deal with it anymore and they feel stuck. Right? So availability of the right support, of the right help in those very particular, you know, times is really crucial to mental health.

Brian "Ponch" Rivera: 42:59

I want to make sure I have this right. It's not necessarily the experience, but it's the reaction or the emotion that we carry that's associated with the experience, right? Is that correct? Correct. Okay. It's not experience. Right. But it but it's the emotion that's connected to it. So because we had a traumatic experience, that doesn't mean we're gonna have PTSD. Am I saying that correctly?

Dr. Yuval Neria : 43:18

Exactly. And so so so so just imagine that in your brain you have the memories. You know, it's a computer, memories in your hippocampus. And the memories can be associated with emotions, but not necessarily. And in fact, our mission is disconnect the memories for from the emotions emotion of guilt, emotion of self-blame, emotion of grief, you know. So the role is to enable the process of disconnected emotions from the memories. And if we don't do that, each time that memory is coming to the surface, it will come with with terrible emotions that eventually can put so much pressure on the human being. Right. That's what's what needed to be done in treatment, really. And that's why it's very important that the treatment will be directly focused on the traumatic accounts and the memories that are related to it, in order to be able to really kind of dissociate emotions from these memories.

Mark McGrath: 44:35

And is that what you call the power to forget, not just the power to remember? Yeah.

Dr. Yuval Neria : 44:40

So having the power to forget. Yeah. Yeah, the power to forget, the imperative of forgetting. Forgetting, this is not in Alzheimer's, forgetting is the bad things. In PTSD, forgetting is a great thing.

Mark McGrath: 44:55

It's interesting. I mean, this this type of discussion, even that we're having, has evolved so much over, say, a hundred years or so, where at some point people would say, oh, they were just shell-shocked, or oh, they were just they just had their um, you know. They didn't get it when they said it. They really didn't get it. Yeah. How far where like where do you like when you when you look at today, I mean, uh clearly we're a lot further ahead, but it it still seems to me like we have a long way to go still.

Dr. Yuval Neria : 45:23

But we did a lot. So I think the I think the early 80s where people eventually got it, you know, after the Vietnam War, they got what PTSD means. They got the idea that PTSD may be a normal reaction to abnormal situation. You know, this is when, you know, clinicians, psychiatrists, psychologists, and veterans and understood what happened to multiple generations before us that were blamed as weak, as cowards, as I don't know what, you know, and hospitalized or left or left, you know. You know, early 80s, kind of, you know, late 70s in the US, especially on the Northeast, you know, Boston areas, where really you could have identified the change. However, you know, 50 years or 45 years later, what I think is missing still is progress on two things. First of all, understanding that PTSD is kind of an umbrella, you know, group of symptoms that is very heterogeneous and and one size doesn't fit all. One size of treatment doesn't fit all. For example, just to give you like a very, very simple example, and I'm sure you can look at yourself and your friends in order to quickly screen for the implication of what I'm gonna say, is that PTSD can can be seen more like an anxiety sometimes, you know, the hyperarousal, the um anxiety, you know, especially early stages after, and very different from PTSD is that looks more like a depression, a lot of guilt, heaviness, you are detached from yourself, from society, a lot of guilt feelings, you feel stuck, you feel like a failure. This is very different from a PTSD in the early ages, where you're basically anxious, cannot fall asleep, cannot concentrate, and all of that, right? There is very little effort, I mean, we have done it scientifically at Colombia, but there is very little effort to look for different treatments for different conditions of PTSD. And when you group everybody together and give them one treatment, like prolonged exposure in the VA, you miss a lot of variants. And that's why you get that 50-60% of the people don't respond to the treatment because they don't have the same disorder to start with. You see what I'm saying? Absolutely, yeah. So the right diagnostics and the right definitions should lead to different treatments. That's first. Second, we we were very much behind developing good treatments. Psychedelics is a perfect example for that. There is a lot of promise with psychedelics. Where have we been in the last 30, 40, 50 years with psychedelics? We did nothing. We did nothing. And we knew that that LSD can work a little bit more or better than we thought. We knew that cytosyping works pretty well. Certainly MDMA has a lot of promise, you know, with all the taboos and and the stereotyping, you know, and FDA abandoned psychedelic altogether. We have lost so many years of progress in this area.

Mark McGrath: 49:12

Yeah, we we agree. And, you know, you've looked at our episodes and you know that we've had a lot of people come on and discuss psychedelics. Most recently we had Dr. Nico Grunman, who's a physician that runs uh Ember Health, which is a ketamine IV clinic here in the city. Um, you know, you and I are both uh here in Manhattan. And and he came and he talked about ketamine therapy, how they were using it originally as an alternative to anesthesia in in combat situations, and then they're realizing that it actually was a way to help mitigate depression, reduce suicidal ideations and that kind of thing.

Dr. Yuval Neria : 49:46

And you know, it hits hard because ketamine ketamine is a lot of problems for PTSD, for depression, even for even even for addiction in a very interesting way. Yeah, well they're Doc. I'm wondering this. Oh, yeah.

Brian "Ponch" Rivera: 50:01

So I'm wondering about this. Um resetting uh disconnecting the event and the emotion, uh resetting that, if you will, that process is no different than the process we need to go through as a culture, going back to your your point about psychedelics and how we kind of took 30 years and just threw it away because we stopped doing that. So this is a kind of a fractal thing, right? We we need to go back and and run a counterfactual and what if scenario, what if these things actually run look like and if we do it this way, if we see this event and disconnect that emotion from that event, that traumatic event, that's no different than what you just said. That's what I'm hearing. So the the way absolutely okay.

Dr. Yuval Neria : 50:40

I think I think psychedelics have promised in two in I mean, I'm talking very generally here. I'm not an expert in psychedelics. I mean I read, I'm reading, you know, the literature, and I'm I'm really hopeful about it, but I'm not an expert. But I think psychedelics have two main effects with relation to trauma. And that's true for ketamine, that's true for MDMA, that's certainly true for SIS. I've been, I don't know enough about LSD, so I can tell you. But psychedelics facilitate a more rich, more truthful uh inner observation and inner discussion about what happened in my life. And how and how should I see that? You know, whether, you know, whether I am right to think that I'm completely fucked, I'm I I have no reason to live, I am to be blamed on everything and anything, or I can look at my life, I can look at myself with more compassion, with more love, with more understanding, and and open open myself to to a more positive outlook about myself and also about the people around me, especially with MDMA. So that's that's one thing that psychedelics can offer, and no other psychiatric drug is able to offer. And that's I mean, I mean, sertalin or peroxetine or any SSRIs will not give you this state of mind. This is really what psychedelics in a very amazing way offer human beings is to see themselves differently, to feel themselves differently, to feel the world around them differently, in a way that they will be and and and change perspective. And that's why they can be also effective in addiction, because addiction, think about it. I mean, you use drugs in order to treat addiction, but not treating it on the physical addiction, treating it on the mind that needs to use those drugs in order to feel better. So if you can stop drinking alcohol because you understand where you're coming from and what you really need, that's fantastic. More than that, I mean neuroimaging studies are showing us that psychedelics can be very effective in kind of rebooting and rebooting um the brain, rebooting circuits, you know, kind of refreshing almost, you know, um brain circuits in a way that it's only it's not only about what you feel, it's also what your brain can enable you down the road, right? So if that's the case, perhaps you need much less talking therapy now. You know, particularly if you are stuck and and and repetitive and going in circles all the time, you know, and and do it, you know, with the support of some psychedelics, then your talking can be much more meaningful and and more and more and more positive about yourself.

Brian "Ponch" Rivera: 54:13

The features that you identified with psychedelics, and I'll I'll uh inner observation. To me, it doesn't need to be psychedelics, it could be a pet, it could be a yoga, it could be meditation, it could be something. And and you pointed out that there are no known, I guess, SSRIs or even benzos or anything like that that allow you to do that inner observation. Another look taking it, you know, kind of going off course away from psychedelics for a moment, if we take those features that you identified, how might that connect to like uh working out or getting a dog? Or I think you do some work with with uh animals as well. Like how can those therapy the other things? Yeah, yeah. Yeah, how does that how do those address those features that you just identified as being what we need to do, which is the inner observation?

Dr. Yuval Neria : 54:59

Right. So again, and guys, I mean you have you ask me really tremendous questions, and you can see that some of them allow me to to reassess and to re-evaluate my my um scientific observations. First of all, about walking out, that's that's a must. You know, that's not even a a question whether it's recommended or not. I mean, if you want not only to live longer, to live better, but also to maintain some balance of your emotional system, of your cognitive system, you know, walking out, you know, doing long walks, you know, doing weights, doing cardio. I mean, that's a must. I mean, that's I mean, I wouldn't even argue anymore about that. There is so much scientific evidence to support it, and that can be a difference between somebody who preoccupied with with um suicidal thoughts versus somebody who are less preoccupied. Okay, so that's about that's about physical exercise. Animals, I mean there is a lot to say about animals. I'm a great fan of nature in general and animals particular, particularly dogs and horses. And the reason I'm faithful about it and so much inspired by this thing is that it's you know, if you look at those two creatures, those two species, you know, horses and dogs, they were the only species that kind of made a decision very early on to join human beings in their lives. You know, dogs came out of the woods, horses came back from, I don't know, deserts and savannas and wherever, you know, and and offer themselves to human beings in their journeys, whatever the journey is. Now, sometimes humans took advantage of it, or many times, you know, and being unfair to um to those amazing creatures, but it is my sense that there is a very deep way why we feel good with our dogs, pets, and why we can be so positively influenced by equine, by horses. Now, I, you know, my team at Colombia and and perhaps my buddy um Matt Riba um will talk about it more in detail. My team at Colombia developed the first of its kind treatment manual for for PTSD for veterans in the US and published the data in serious um in serious scientific journals, where we we have seen that eight weeks of group therapy of veterans, men and women, in a protocol that we build on the ground, not even mounting on horses, you know, can do amazing things. So people with chronic PTSD that I described before that are not responsive anymore to anything that the VA offers them. And you can see PTSD and depression dropping down significantly. There is something with horses. Horses are very similar to people with PTSD. They are hyper-vigilant, they are easily afraid, they are obsessed with safety. Horses are prey animals always on the guard. You know, they interact, they get people with PTSD right away, and then if you walk between the two on bonding and on coordinated efforts, you know, starting from cleaning the horse or cleaning the hoofs, all the way, leading the horses, joining the horses, you know, you can see an amazing effect that are going directly to the brain because we don't talk about trauma when we when we prescribed equine therapy for PTSD. We don't talk about the abuse or whatever, sexual abuse, you know, or combat trauma. And you can see an amazing effect that it's on hormonal level, etc. Yeah. And those are the ways to get, and that's a response to you, uh punched, that this is how we move the attention, our attention patterns from being preoccupied with our own pain to something outside. That we don't need or to speak about the pain, to feel the pain all the time. Physical exercise and bonding with human beings, bonding with with animals are the best.

Mark McGrath: 1:00:01

How easy is it though? It seems like people tend to fall into the trap of drugs, I guess our culture, you know, largely being driven, at least marketing, you know, with pharmaceuticals. But I was thinking of another thing as you were talking, you know, we were thinking about uh, you know, dogs and horses. One of the things that if you've ever seen on YouTube, there's bazillions, millions of hits on on Soft White Underbelly, and they they interview all sorts of people like crack addicts and and heroin junkies and porn stars and strippers and hookers and things like this. And almost all of them, as they tell their story, almost all of them have some manner of trauma, like some kind of traumatic experience. And rather than having a dog or a horse or or psychedelics or whatever, you know, they dealt with their trauma through vice or they dealt with it through illegal drugs, or they dealt with it through, you know, a life that would be, you know, considered by most uh you know amoral or whatever. But it but it really seems that it can go the opposite way if you don't treat it correctly, right? I mean it it c it can really go south quickly.

Dr. Yuval Neria : 1:01:04

Because people are looking for relief. We talked about the emotional pain before. People are looking for relief. They are will do everything. They will take cocaine or or even other drugs. They will drink to their uh you know um in an unlimited way. They you know they cannot stop smoking marijuana. They will be they will be addicted to sex or to social media or whatever, because they are looking for relief. In their inner pain, in their self-blame, sense of failure, anger, you know, feeling of being abandoned, being betrayed. Those are really the um and it's so repetitive and it's so common, unfortunately. Yeah. It is what it is. If we don't, you know, so that's why trauma is so is so common among people who struggle. It's many times about trauma. And that's why it's not only PTSD, as you suggest. It can be depression without PTSD, it can be addiction without PTSD. What about it?

Mark McGrath: 1:02:18

What about something like, you know, uh we both live in Manhattan and you walk through Penn Station and you see people having arguments with the air or they're they're fighting the air, and you know, they're they're clearly maybe schizophrenic. Is that some kind of another response to trauma is schizophrenia?

Dr. Yuval Neria : 1:02:35

I think schizop I think schizophrenia bipolar in this is a different story. Okay. I mean, psychiatrically. It's a different, it's an option for the brain to get completely out of order and mostly about genetic stuff. Um trauma can accelerate the pace many times, but it's not necessarily singularly related to the trauma, as we discussed before about our area of research.

Brian "Ponch" Rivera: 1:03:03

I'm curious, people say that we have a mental health crisis globally here in the U United States. And then you look at the you know, the access that my kids have to what's going on around the world, they could see live events or events that are recorded, traumatic events. So vicarious trauma. Uh, can we, even though you and I didn't experience something that happened somewhere around the world, but we watched the video of it, can that can that create trauma? Is that is that possible?

Dr. Yuval Neria : 1:03:27

To a small extent, particularly if if you have the risk factors of previous trauma of yourself or trauma that you didn't deal with. And so social media can, or you know, the screens can bring back to you. So, you know, with I I don't want to over-generalize and to over-scare people so much. I mean, addiction to social media is bad anyway, but in order to develop PTSD, because you have seen uh an awful, uh, gruesome video, it can happen if you have enough risk factors, you know, that can accelerate this, you know, this exposure. I want to go someplace that but in general, before we move on, people are very resilient. You know, 70-80% of people who will experience any trauma. Any trauma, even October 7 in Israel, you know, 80% of them will they will never forget what they have seen or experienced, but eventually overcome it. You know, you can see it again and again in all our studies that most people are able to rebound quite effectively to what happened to them. So each time it's about 20, 25 percent of people that you know met their limits and need to be need to be taken care of.

Brian "Ponch" Rivera: 1:05:02

Doc, I want to touch on a sensitive issue, and and the way I bring it up, um uh please for you know, I want to put a caveat there to our listeners that this is my perspective, and I may be wrong on this. Years ago, I was involved with uh a documentary on PTSD and psychedelic assistant therapy targeting the military aviation community. One of my jobs that I self-selected for was to reach out to find our sisters in arms that flew female pilots, women combat pilots, and asked them to join this conversation. What I discovered uh in those conversations is they I don't know, I'll just give you a phrase that I heard. Hey, Ponch, the trauma I have isn't from combat, it's from sexual assault. Right. And that just floored me because I wasn't expecting that, right? So uh can you talk a little bit about that? And I think I think this is very important that uh we, you know, there's three males on this episode right now. We've got to address this. And and Doc, do you mind?

Dr. Yuval Neria : 1:05:53

No, of course. Thank you for bringing it up. Sexual assault and are v are very common in the military, particularly towards women, but not only. There are um a lot of male um service members that experience um all sorts of traumatic sexual experiences that against their will. But it's very common among among female or female, you know, service members. And that's and that's so bad. I'm s I'm saying that because I've seen, you know, in my in our Veterans Center at Colombia, we have seen that again and again what you just said, Panch, that that you know, those um accounts from from survivors that uh uh that that can compare to any other traumatic experience and say this the social sexual violence is the most horrific one. And first of all, I want to explain why. Because it's always, always, always, almost always entail a sense of betrayal. You are always assault assaulted by people who you think need to protect you. You know, either it's military commanders or it's it's peers, you know, that you trusted them. Uh you thought they look at you equally any other team member, and it's some reason they betray this code and attack, you know, either the weakest member or the female member, uh, because it's not only about sex, it's not certainly not about sexual desire or sexual intimacy, which is an acceptable and admirable thing to have in life. It's it's about it's about inflicting pain and power and all of that. So that's common, and it's always involved, as I said, you know, a betrayal of trust and and betrayal of leadership. And and and and and and and and um and it's it's changed dramatically how you can see other people in your environment. I mean, if you are if you need to protect yourself from it's it's it's in the family, right? For kids and for adolescents. It always like, you know, a cousin, even a father, that betray betray their duty to be responsible, you know, um human partners and attack the kid or or the female. So all within you know um domestic um environment. So what I would like to s to say that it's um so there is a sense of that, and and then it's about vi uh I mean somebody really violate your uh body, you know. So I told you guys that I um I did this huge study on POWs and and and the worst uh form of uh torture was not being beaten up or sometimes um you know really beaten up uh awfully starved, humiliated. The worst type of violence uh in captivity is that when your captors sexually molested the prisoners. Um and that's that's the worst trauma. So um it's um traumas vary in severity, so sexual violence is probably the worst the worst form of traumatization, and that's why it always, I mean, you always see about 80% or so of people who experience rape and severe sexual violence to develop psychopathology, especially depression and PTSD after the exposure.

Mark McGrath: 1:10:16

Well the work that you were doing over there with the POW is just to kind of stay in this because the you know the militaries have evolved that we are not only a band of brothers, we're we're we're a band of brothers and sisters. Right. It also's been I from from my observation, it seems that Israel has a much different way that they've integrated women into their force than in the United States.

Dr. Yuval Neria : 1:10:42

Yeah, you it's funny. It's it's true what yeah, it's true, uh Moose. We don't I mean, inflicting sexual violence on females in the military is is not so common in Israel. What is more common is um you know, less extreme forms of like bad, you know, relationships or whatever, treating treating, I don't know, treating women in the military as kind of servants or you know um but but the the female and the female and work female soldiers in Israel, in Israel everybody you know is going to the military. All all men and women aged 18 are going to the military, so you don't see a lot of of involuntary sexual experiences and which is which is good. In this country in the US, you it's more frequent and it's it's coming with a lot of emotional scars to our female veterans, unfortunately. And and it's funny that it's really funny or or it's surprising for me, I would say, that there is not enough informal enforcement of just stop it. You know, it's unacceptable, it's awful, you know. How can a big system like ours is not more effective in banishing people who are involved in that, in you know, just stooping that? It's it's beyond me. Just to tell you the truth.

Mark McGrath: 1:12:31

I mean, yeah, I mean it's such a w what do you think would be so you know, there's a there's a we we we started before we were recording about the things that the IDF has inspired, you know, the Marine Corps and that John Boyd, our our guy studied. It you know, in that respect, what do you think is the biggest lesson to take away of like the integration of females into the force to that that that the Israelis seem to be much better at than than than we have? What do you think is the big differentiator of why we have not done it as well?

Dr. Yuval Neria : 1:13:04

I think here you do better in terms of integrating um females in combat. You know, I mean the number of aviators, the number of combat medics, and females are everywhere in the American military. In Israel, it's still not that. You know, I think we are still more perhaps in the IDF, more a little bit more sexist or more, you know, uh or you know, you know, there is we don't see a lot of female pilots or combat pilots as you see in this country, uh helicopter pilots, you know, you don't you don't see it enough in the Israeli military, but it's true that um, you know, what we said before, that um there is, I don't know, I mean, there is a sense of uh empowerment, empowerment that I think female soldiers experience or feel in the IDF that perhaps protects them better and makes them um more equal in a way. Interesting.

Mark McGrath: 1:14:19

Well, Doc, I think we could go for hours. There's so many, there's so many there's so many areas we want to connect the dots on and and and even specifically dig more into the into the science. One of the things that we have not dying. Well, one of the things that Parch and I say a lot to guests is they somebody knows everything about John Boyd's theories without knowing anything about John Boyd's theories because the the the intersection is so so powerful. But the from the concept that we talk about continuously about orientation and understanding the orientation is prime and our cognitive software are so important. I mean, you've not only reinforced that, but um, hopefully we're we're mutually finding ways to take things in different directions and keep working together and talking about these things together. Uh Punch, anything to add on?

Dr. Yuval Neria : 1:15:06

Yeah, I'm looking forward to speak. I'm look I'm looking forward to speak more in the in the future. So I'm around, you're around, you're doing a terrific job. Thank you. Let's talk more someday.

Mark McGrath: 1:15:16

Absolutely. All right. Well, we're gonna s we're gonna end the recording here, but Dr. Yuval Naria, we really appreciate you taking the time and uh and and sharing that with us and sharing your stories and and your work with our with our audience. Happy to do that. Thank you. Thank you.